Foregut pathology Flashcards
List symptoms of upper GI disease
Chest pain Abdominal Pain Bleeding Nausea/Vomiting Dysphagia Anorexia Early Satiety Bloating
On gross examination of the esophagus and the GEJ, squamous epithelium appears ____ and glandular epithelium appears _____ in color
squamous: white
glandular: tan or pink
A “bag of worms” appearance on gross examination of the esophagus suggests
esophageal varices
dilated veins below the mucosal surface
Histologic findings below suggest what diagnosis?
basal cell hyperplasia, intercellular edema, vascular congestion, extension of papillae toward the surface, inflammatory cell infiltrate (lymphocytes and eosinophils)
reflux esophagitis
List complications of reflux esophagitis
erosion and ulceration
squamous papilloma
strictures
Barrett’s esophagus
In ____, children usually have an identifiable allergic cause but adults do not
eosinophilic esophagitis
Histologic findings below suggest what diagnosis?
Prominent intraepithelial eosinophils, eosinophilic microabscesses, intercellular edema, lamina propria fibrosis
eosinophilic esophagitis
In order to diagnose candida esophagitis, you must see _______ of fungal elements
invasion
candida may be part of normal microflora, so surface fungal elements are not diagnostic
_____ esophagitis is usually an opportunistic infection in immunosuppressed people but can also be seen in immunocompetent children
herpes
______ usually presents with
- Ulcer with necrotic debris and exudate with neutrophil
- Viral inclusions are present in multinucleated squamous cells at margin of ulcer
herpes esophagitis
_______ usually presents with:
- Virus present in enlarged endothelium and stromal cells at ulcer base
- Basophilic cytoplasm often has coarse intracytoplasmic granules
- Prominent intranuclear basophilic inclusions surrounded by clear halo (“Owl’s Eye”)
CMV esophagitis
Differentiate herpes esophagitis from CMV esophagitis
herpes- present in squamous epithelium at surface of ulcer
CMV- present in endothelial cells deeper at the ulcer base
Patients with Barrett’s esophagus are at increased risk of esophageal ________
adenocarcinoma
Differentiate low grade from high grade dysplasia in the context of Barrett’s esophagus
low grade: nuclei are basally oriented
high grade: nuclei are apically oriented, my have more abnormal shape
both grades show mucus depletion and prominent cytoplasmic basophilia
________ is typically is an exophytic mass with gastric rugae present below and pale squamous epithelium above, present in the distal esophagus
Adenocarcinoma of the esophagus
______ is typically an exophytic, excavated, or infiltrative mass in the middle of the esophagus
squamous cell carcinoma of the esophagus
What is the precursor lesion for squamous cell carcinoma of the esophagus?
squamous dysplasia
- loss of normal maturation
- mitosis present above the basal layer
List cause of acute and chronic gastritis
acute gastritis
- drugs: EtOH, NSAIDs, steroids
- bile acids, uremia, shock, stress
- acute infection
chronic gastritis
- H pylori infection
- autoimmune gastritis
- reactive gastropathy
How is H pylori diagnosed?
Histologic examination with or without special staining
Urease test using biopsy material
Urea breath test
Serologic test for antibodies to H. pylori
Molecular methods (PCR, ribotyping)
What are complications of H pylori gastritis?
Peptic ulcer
Gastric adenocarcinoma
MALToma
Antibodies in autoimmune gastritis are typically against:
parietal cells or intrinsic factor
anti-parietal cell antibodies are to the K/H APTase proton pump
Loss of parietal cells in autoimmune gastritis leads to:
- hypochlorhydria
- loss of intrinsic factor (B12 malabsorption, pernicious anemia)
- low acid stimulates gastrin release lading to hyperplasia of antral G cells
Gastric carcinoma is most frequently in the ______ area and along the _____
pyloric area and lesser curvature
The ____ type of gastric adenocarcinoma presents with a bulky exophytic mass
intestinal
The _____ type of gastric adenocarcinoma presents with infiltrative thickening of the stomach wall leading to the “leather bottle” appearance
diffuse
Signet ring cells are associated with ______ gastric adenocarcinoma
diffuse
Positive staining for CD20 (B lymphocytes) suggests _____
MALToma
What is Plummer- Vinson syndrome?
Dysphagia due to esophageal webs, glossitis (inflammation of tongue), iron deficiency anemia; patients are at increased risk of squamous cell carcinoma of cervical esophagus
Describe the microscopic findings of reflux esophagitis
Acute inflammatory cells in epithelial layer (eosinophils, neutrophils, excess T cells)
Basal cell hyperplasia and elongation of lamina propria papillae into upper 1/3 of epithelium
Ballooned squamous cells
Describe the gross appearance of eosinophilic esophagitis
White plaques Stipple-like exudates Linear fissures Ringed esophagus Strictures Impacted food
Describe the microscopic appearance of eosinophilic esophagitis
Prominent intraepithelial eosinophils Microabscesses Basal cell hyperplasia Intercellular edema Lamina propria fibrosis
What two criteria MUST be present to diagnose Barrett’s esophagus?
a) Must see abnormal epithelium at endoscopy ABOVE the GEJ
b) Histologic evidence of columnar epithelium with goblet cells on biopsy
Describe the gross appearance of a peptic ulcer
Peptic ulcers occur in the first part of the duodenum and in the gastric pylorus/antrum
Classic peptic ulcer is a round to oval, sharply punched-out defect in the mucosa
Differentiate the microscopic appearance of acute vs chronic ulcers
- Acute ulcer: Acute necrosis of surface epithelium. Underlying this is a zone of granulation tissue which consists of budding
young capillaries and proliferating fibroblasts inflammatory cells. Below this is a zone of collagen deposition with healing which takes place
from below upwards - Chronic ulcer: granulation tissue is replaced by scar tissue
